CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA

Childhood acute lymphoblastic leukemia (childhood ALL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). Childhood acute lymphoblastic leukemia (also called childhood acute lymphocytic leukemia) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. It is the most common type of cancer in children.

In ALL, too many stem cells develop into lymphoblasts or lymphocytes (a type of white blood cells). These cells may also be called leukemic cells. The leukemic cells are not able to fight infection very well. Also, as the number of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, anemia, and easy bleeding.

Risk factors for childhood ALL

Having a brother or sister with leukemia

Being white or Hispanic

Living in the United States

Being exposed to x-rays before birth

Being exposed to radiation

Past treatment with chemotherapy or other drugs that weaken the immune system

Having certain genetic disorders, such as Down syndrome

Symptoms of childhood ALL

Fever

Easy bruising or bleeding

Petechiae (flat, pinpoint spots under the skin caused by bleeding)

Bone or joint pain

Painless lumps in the neck, underarm, stomach, or groin

Pain or feeling of fullness below the ribs

Weakness or feeling tired

Loss of appetite

Diagnostic tests for childhood ALL

Physical exam and history including checking for signs of disease, such as lumps or anything else that seems unusual

Complete blood count (CBC) with differential

Bone marrow aspiration and biopsy to look for abnormal cells in the bone marrow, blood, and bone

Cytogenetic analysis to find out if there are certain changes in the chromosomes in the lymphocytes

Immunophenotyping to find out if malignant (cancerous) lymphocytes began from the B lymphocytes or the T lymphocytes

Blood chemistry studies to measure the amounts of certain substances released into the blood by organs and tissues in the body

Chest x-ray

Treatment of childhood ALL

Treatment options depend on:

Age and white blood cell count at diagnosis

How quickly and how low the leukemia cell count drops after initial treatment

Gender and race

Whether the leukemia cells began from the B lymphocytes or the T lymphocytes

Whether there are certain changes in the chromosomes of lymphocytes

Whether the leukemia has spread to the brain and spinal cord

Whether the child has Down syndrome

Treatment of childhood ALL is overseen by a pediatric oncologist who works with a team of other pediatric health professionals to treat the illness. The team may consist of: Hematologist, Medical oncologist, Pediatric surgeon, Radiation oncologist, Endocrinologist, Neurologist, Neuropathologist, Neuroradiologist, Pediatric nurse specialist, Social worker, Rehabilitation specialist, and Psychologist.

The treatment of childhood ALL usually has 3 phases:

Induction therapy: This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission. This is also called the remission induction phase.

Consolidation /intensification therapy: This is the second phase of therapy. It begins once the leukemia is in remission. The purpose of consolidation/intensification therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse.

Maintenance therapy: This is the third phase of treatment. Its purpose is to kill any remaining leukemia cells that may regrow and cause a relapse. Often the cancer treatments are given in lower doses than those used for induction and consolidation/intensification therapy. This is also called the continuation therapy phase.

Treatment options used for childhood ALL include:

Chemotherapy: Use of drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

Radiation therapy: Use of high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Can be external radiation therapy or internal radiation therapy.

Chemotherapy with stem cell transplant: Stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body`s blood cells.

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